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Section 14
Track #14 - Physical Health

Question 14 found at the bottom of this page
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On the last track, we discussed the several types of substance abuse most common in bipolar disorder clients:  alcohol, illegal drug abuse, and nicotine.

On this track, we will examine ways that bipolar clients can adjust their living habits to help them better cope with their disorder:  regular mealtimes; eating natural foods; and regular exercise.

#1 Nutrition:  Regular Mealtimes
The first change in living habits that we will discuss is nutrition.  As you know, clients with mood disorders are much more sensitive to chemical imbalances.  As you know, without a proper balance of vitamins, proteins, and carbohydrates, a bipolar client’s condition can actually worsen.  This can
be especially true during a manic or depressive episode when appetites can fluctuate enormously.  One technique I have found that often helps bipolar clients is Regular Mealtimes.  Eating at the same time everyday helps to keep blood sugar in balance.  One of my clients, Tony, had a very strict
regimen that also helped him to remember his medications as well as keep him energized the entire day.  Keep in mind that Tony’s condition was slightly exceptional because he was also treating several other health concerns such as a low thyroid, systemic arthritis and allergies.  Tony stated, “When I first wake up, I take my thyroid medicine because my body absorbs it best on an empty stomach. Then I do  a brief set of exercises, shower, dress, and eat a decent breakfast afterward.  In the late morning, I eat a homemade muffin with my next batch of medication.  I eat a late lunch, then have a piece of fruit and sometimes a caffeinated diet soda when my energy drops around 3:30 or 4 p.m.  Around 5:30 I take my allergy medications with only water.  I take another batch of
medication at dinnertime and my last doses of the day with a bedtime snack.” As you can see, Tony kept a daily schedule of mealtimes and snacks by responding to his body’s natural signals.  Obviously, each client’s meal schedule will be different according to their own needs.  The important thing is that he or she develops a routine that maximizes their energy and glucose levels while also complimenting their medication doses.

#2 Nutrition:  Natural Over Processed
In addition to eating regularly, I encourage my clients to eat as many natural foods as they could which includes raw fruits and vegetables, nuts and seeds, whole grains, and chicken and fish.  I also recommend them to limit their intake of artificial sweeteners and white-flour products.  Could you be overlooking you clients eating habits and the effect these habits have on their discorder? Also,
sugar can greatly affect a sensitive person’s mood.  Shifts to hypoglycemic states can cause someone to feel less energized, irritable, or dizzy.  For those clients who do not wish to give up sugar entirely, I suggest a few snacks of fruit a day.  Fructose, the natural sugar found in fruits, has the least noticeable affect on blood glucose levels.  Caffeine is another product I ask my clients to use less of.  Not only does caffeine affect glucose levels, it also interferes with sleep, and, as we discussed on track 6, sleep is essential in controlling manic and depressive episodes.  I often notice that those clients with major depression consume great amounts of caffeine a day.  Before Tony began his own dietary regimen, he reported consuming three pots of coffee and several dietary sodas a day during a depressive episode.  Some clients cannot go without coffee, and for those that can’t I recommend only drinking one cup early in the morning and to avoid drinking it late afternoon as it could affect sleep.

#3 Exercise
In addition to regular mealtimes and eating natural foods, I have found that regular exercise can benefit those clients with irregular mood shifts. Obviously regular exercise can reduce anxiety, improve concentration, and increase energy.  For those with bipolar disorder, it’s doubly efficient, energizing those with depressive moods and burning off energy for those undergoing manic episodes.  Normally, aerobic exercise accomplishes this.  A regular exercise routine of thirty to sixty minutes of aerobic exercise three times a week can effectively energize a client.  However, I have found that many clients overshoot their exercise capacity and report becoming sluggish and tired.  For this reason, I encourage clients to work up to a workout regimen gradually and develop one that is challenging, but not daunting.  Several clients have also found it useful to do toning or nonaerobic exercises such as yoga or weight lifting on the days after their aerobic exercises.  I also
caution my clie nts taking lithium to remain sufficiently hydrated because during hydration, lithium levels can become toxic.

Technique:  List of Small Steps
No doubt exercise is beneficial, but the real issue ishow do you get your bipolar client to exercise?
Clearly, making many of these changes can be excruciatingly difficult for many clients who are set in their ways.  Exercise seems to be particularly difficult to continue.  To help those clients who cannot seem to make living-habit changes, I give them my “List of Small Steps”.  This is a helpful list of
suggestions for clients to follow when trying to change their living habits. The first few suggestions address exercise.
1. Find an activity-or preferably several-that you enjoy.
2. Make a commitment.  Plan regular workouts with a friend, join a gym, or take a class.
3. Keep your exercise gear packed and ready to go.  When you return from a workout, immediately repack your bag with clean exercise clothes.
4. Buy exercise videos or equipment (a standing bicycle, treadmill, rowing machine or weight set) if you prefer to exercise at home.
5. Start with something as simple as a regular 10 minute walk, and slowly build up.
6. Establish a regular bedtime and do your best to obtain adequate sleep. Make it a top priority.  (Refer to track 6 for more information about the sleep-wake cycle and helping clients regulate it.)
7. Eat regular meals and a balanced diet.  Unless you’re taking MAOIs, you can make dietary changes gradually.  Cut back on sugar and caffeine first, and make other changes as you feel ready.
8. If you’re not used to taking medication, and your doctor prescribes it, set up a way to help you manage it.
9. If you self-medicate with alcohol or drugs, get treated for substance abuse or join a self-help program such as AA.
10. Aim to reduce the stress in your life.  (Refer to track 12 for more information on reducing clients’ stress)

By following these guidelines and taking small steps to habit changes, there are less variables to affect a bipolar client’s moods.

The health points on this tract are common sense, but are youo overlooking the importance of bringing thses common sense health practices to your client’s attention again?

On this track, we presented ways that bipolar clients can adjust their living habits to help them better cope with their disorder:  regular mealtimes; eating natural foods; and regular exercise.

QUESTION 14
What are three ways that bipolar clients can adjust their living habits to help them better cope with their disorder? To select and enter your answer go to Answer Booklet.

This CD set has covered such topics as: Educating the Bipolar Client, Treating a Resistant Client, Clients During Psychosis, Predicting Mania or Depression, Comorbid Conditions, The Sleep-Wake Cycle, Differences Between the Sexes, Temperamental Disturbances, Suicide, Upbringing, Medication and Other Treatments, The Effects of Stress, Substance Abuse, and Physical Health.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute at homestudycredit.com as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Teen Self Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship. 

I wish you the best of luck in your practice. Thank you.  Please consider us for future home study needs at homestudycredit.com